Water and dialysis fluids: How to avoid dangerous contaminations

Current opinions among nephrologists indicate that water quality is even more important for the longterm clinical success of hemodialysis therapy than the biocompatibility of dialysis membranes. Dialytic therapies, such as haemodiafiltration (HDF) or high volume haemodiafiltration, have become popular due to their improved performance followed by a better patient survival. Dialysis modes, such as HDF, need large volumes of substitution fluids that have to be prepared from water of appropriate quality level, Carlo Boccato and colleagues report in their introduction to the new textbook "Water and Dialysis Fluids - A Quality Management Guide".

"A typical patient on hemodialysis therapy is exposed to 18.000-30.000 L water annually in the form of dialysis fluid - in case of high volume haemodiafiltration to even 3.000 L more. This exposure may afford opportunities for blood contact with pyrogenic contaminants.

Molecules which may be present in dialysis fluids can move from the dialysate compartment of the dialyzer to the patient´s bloodstream by means of internal filtration. If such molecules are endotoxins, exotoxins or fragments of bacterial walls, the transfer of such compounds must be considered a health hazard.

This problem has become even more prominent when online preparation of substitution fluids of haemofiltration and haemodiafiltration became available. It is therefore no surprise that membrane manufacturers have invested in polymer research and realized technological approaches to guarantee the provision of pure water and ultrapure dialysis fluid for both, haemodialysis and haemodiafiltration. Detailed investigations have been performed to prove, whether it can be excluded that bacterial contaminants can reach the blood stream by adsorptive mechanisms in the membrane wall of dialysis membranes ..."

Carlo Boccato, David Evans, Rui Lucena, Jörg Vienken: Water and Dialysis Fluids - A Quality Management Guide. Pabst, 264 pages
Hardcover ISBN 978-3-95853-111-6 http://www.pabst-science-publishers.com/index.php?30&backPID=30&swords=boccato&tt_products=177
ebook ISBN 978-3-95853-112-3 http://www.ciando.com/ebook/bid-1999484-water-and-dialysis-fluids-a-quality-management-guide.html?CFID=d2493128-a275-4033-8cf8-b301afc5a265&CFTOKEN=0&jsessionid=D35BD07C01BF7703D7EE4976FA217011

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